Polyethylene wear debris and tissue reactions in knee as compared to hip replacement prostheses

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Abstract
Differences in bearing surface conformity and wear mechanisms suggest that the polyethylene (PE) wear debris generated by total knee replacement (TKR) prostheses should be different than that in total hip replacement prostheses (THR). To address this issue, PE wear debris and the cellular response in periprosthetic tissues from 19 failed TKRs was compared to that from 24 failed THRs using polarized light microscopy and a semiquantitative grading system. The foreign-body inflammatory reaction in the THR cases was characterized by plump macrophages with a diffuse cytoplasmic birefringence when examined under polarized light, indicating the presence of multiple submicron particles of PE. The majority of the PE particles were 10 μm. The foreign-body inflammatory reaction in the TKR cases was characterized by giant cells with fewer macrophages. In the TKR specimens, the size range of PE particles was broader than in the hips. PE particles between 2 and 20 μm were frequent in TKR specimens; particles <1 μm in length were less common than in the THR specimens. Diffuse cytoplasmic birefringence was not a characteristic of the TKR cases. These histologic differences were so consistently distinct that the source of the specimen (i.e., from a THR or TKR) could be blindly determined by light microscopy. The size distribution of the PE wear particles in these cases indicate that THRs generate a higher number of submicron PE particles and relatively few large particles while TKRs generate a broader range of particles that includes fewer submicron particles. The observed differences in the cellular responses is likely a direct result of the differences in the spectrum of PE wear particles. These differences may in part account for differences in periprosthetic bone resorption and loosening in TKRs as compared to THRs. © 1994 John Wiley & Sons, Inc.